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Requirements for all providers

  • Data sharing and IT requirements

    Monument Health requires providers to demonstrate data connectivity with Quality Health Network (QHN), our regional health information exchange (HIE). Connectivity is defined as having “inbound” and “outbound” capabilities  (i.e., the ability and willingness to both send and receive data in QHN).  As Monument Health continues to build its analytic capabilities, there may be other or additional technical requirements.

  • Clinical Guidelines & Quality Measurement Requirements

    Primary Care Guidelines
    and Metrics

    There are currently five primary care guidelines on which practices are measured: hypertension, asthma, diabetes, BMI, and pediatric weight assessment.

    Care Coordination Guidelines
    and Metrics

    There are currently ten care coordination guidelines on which practices are measured: emergency department, hospitalists, hospital case management, primary care, home health and more.

    Specialist Guidelines
    and Metrics

    There are several guidelines on which specialists are measured spanning emergency department, hospitalists, critical care, home health, radiology, orthopedics and others.

     

  • Operational Requirements

    Citizenship

    Physician attendance at quarterly meetings; care coordinator attendance at quarterly meetings; other events as planned

    Analytics

    Use of reports and analytic tools for attribution, risk scoring and utilization

Additional Requirements for Primary Care Providers

Monument Health wants all individuals enrolled in its health plan products to establish a relationship with a primary care provider. Our Tier 1 primary care providers, in turn, agree to be accountable for the health of their patient population. That demands preparation and commitment to deliver exceptional care.

All our Tier 1 primary care practices have met specific requirements that demonstrate their capabilities.

  • What's Required

    Complete three Rocky Mountain Health Plans (RMHP) Practice Transformation courses

    OR

    Demonstrate equivalency through the RMHP Practice Transformation Assessment

    OR

    Participate successfully in the Comprehensive Primary Care Plus (CPC+) program for one year or longer

    PLUS

    Achieve NCQA’s Patient-Centered Medical Home (PCMH) designation (or be in “pending” status)

    Questions? Contact RMHP’s Practice Transformation Team. Call Cynthia Mattingley RN, BSN, at 970-254-5752, or email cynthia.mattingley@rmhp.org

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  • Why are we asking you to become a medical home?

    A growing body of scientific evidence shows that medical homes save money by reducing hospital and emergency department visits, reducing health disparities and improving patient outcomes. What’s more, the PCMH is truly a patient-centered care model—returning the joy to the practice of medicine.

    The NCQA PCMH certification designates a practice has achieved the highest medical home standard (see the evidence). Medical home capabilities include

    • Patient-Centered Access,
    • Team-Based Care, including culturally and linguistically appropriate services
    • Population Health Management
    • Care Management and Support, including medication management
    • Care Coordination and Care Transitions
    • Performance Measurement and Quality Improvement
  • Assistance for Primary Care Practices

    We want to help you get started with practice transformation.

    Monument Health primary care practices are supported by the work of RMHP’s Practice Transformation program. Its team of professionals provides a suite of evidence-based tools and on-the-ground coaching and talent development, including Quality Improvement Advisors, Clinical Informaticists and an integrated Behavioral Health Consultant. Learn more about restoring the joy of medicine through practice transformation or download the RMHP Practice Transformation brochure.

    Contact RMHP’s Practice Transformation Team to learn more: Cynthia Mattingley RN, BSN. Call 970-254-5752 or email cynthia.mattingley@rmhp.org

  • About the Comprehensive Primary Care Initiative

    Many of Monument Health’s Tier 1 primary care providers qualify for the network because they participate in the Comprehensive Primary Care initiative, a demonstration sponsored by the Center for Medicare and Medicaid Innovation.

    This four-year multi-payer initiative offers population-based care management fees and shared savings opportunities, based on provision of a core set of comprehensive primary care functions. CPCi (and coming soon, CPC+) has the potential to make broad-based, comprehensive transformation and payment reform a reality in primary care. And that will have a lasting impact on the health of Western Coloradoans.

Questions?
Call us. 970.683.5630

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